Home > Patients & Visitors > Health Library > Achilles Tendon Problems
Achilles tendon connects the calf muscle to the heel bone. It lets you rise up on
your toes and push off when you walk or run.
two main problems are:
Problems with the Achilles tendon may seem to happen
suddenly. But usually they are the result of many tiny tears in the tendon that
have happened over time.
Achilles tendinopathy is likely to occur in men older than 30. Most Achilles tendon ruptures occur in people 30 to 50 years old who are recreational athletes ("weekend warriors"). Ruptures can also happen in older adults.
Achilles tendinopathy is most often caused by overuse or repeated movements during sports, work, or other activities. For example, if
you do a lot of pushing off or stop-and-go motions when you play sports, you
can get microtears in the tendon.
Achilles tendon rupture is most often caused by a sudden, forceful motion that stresses the calf muscle. This
can happen during an intense athletic activity or even during simple running or
jumping. Middle-aged adults are especially likely to get this kind of
Symptoms of Achilles tendinopathy include swelling in the ankle area and mild or severe pain. The pain
may come on gradually or may only occur when you walk or run. You may have less
strength and range of movement in the ankle.
Symptoms of an Achilles tendon rupture may include a sudden, sharp pain. Most people feel or hear a pop
at the same time. Swelling and bruising may occur. You may not be able to
point your foot down or stand on your toes.
doctor can tell if you have an Achilles tendon problem by asking questions
about your past health and checking the back of your leg for pain and swelling.
If your symptoms are
severe or don't improve with treatment, your doctor may want you to get an
ultrasound scan, or
Treatment for mild Achilles
tendon problems includes rest,
over-the-counter pain medicine, and stretching
exercises. You may need to wear well-cushioned shoes and change the way you
play sports so that you reduce stress on the tendon. Early treatment works best
and can prevent more injury. Orthotic shoe devices can also help reduce stress on the tendon.
Even in mild cases, it can take weeks
to months of rest for the tendon to repair itself. It's important to be patient
and not return too soon to sports and activities that stress the tendon.
Treatment for severe problems, such as a torn or ruptured tendon, may
include surgery or a cast, splint, brace, walking boot, or other device that
keeps the lower leg and ankle from moving. Exercise, either in physical therapy or in a
rehab program, can help the lower leg and ankle get strong and flexible again. The tendon
will take weeks to months to heal.
Although treatment for Achilles
tendon problems takes time, it usually works. Most people can return to sports
and other activities.
Learning about Achilles tendon problems:
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Achilles tendinopathy is most often caused by:
Achilles tendon rupture is most often caused
Achilles tendinopathy may include:
Symptoms of an
Achilles tendon rupture may include:
If you have a partial rupture (tear) of the Achilles
tendon, you may have near-normal strength and less pain after the initial
injury, compared to what you would have after a complete
Achilles tendinopathy starts with repeated small tears in the tendon. These tears may cause no
obvious symptoms. Or they may cause mild to severe pain during movement. As the tearing
continues, the leg may weaken and the tendon pain may become constant. Abnormal
growths (nodules) may form in the tendon, and it may thicken.
Without rest and treatment of Achilles tendinopathy,
you may develop long-lasting (chronic) pain.
An Achilles tendon
can partially tear or
completely tear (rupture). A tear usually occurs in the tendon about
1.5 in. (3.8 cm) to
2.5 in. (6.4 cm) above where it attaches to the heel bone. Some doctors believe that this area
is most likely to tear or rupture because of a limited blood supply.
If you don't treat an Achilles rupture, you will feel
weakness in your first steps when you walk. It may feel like walking in the sand. Over time, walking will become difficult.
can affect the Achilles tendon area. These other
conditions are caused by inflammation. They include:
Things that increase your
Achilles tendinopathy or
Other risk factors for an
Achilles tendon rupture include:
Call your doctor right away if you think you have an
Achilles tendon problem (at or above the back of your ankle) and:
If you have had an Achilles tendon injury in the past and
you have reinjured your Achilles tendon, call your doctor to find
out what you need to do. Rest your lower leg and foot until treatment
Watchful waiting is a period of time during
which you and your doctor observe your symptoms or condition
without using medical treatment. Watchful waiting is not a good idea if you
have severe pain in the Achilles tendon area. If you think you have injured
your Achilles tendon, call your doctor. Early treatment is most
If you think you have
Achilles tendinopathy and you have mild symptoms, rest your lower leg and foot
for a couple of days. Follow the other steps in Home Treatment. If you have weakness, cramping, or
constant pain in your Achilles tendon, call your doctor.
Health professionals who can diagnosis and treat an
Achilles tendon problem include:
You may be referred to a
physical therapist for exercises to rebuild strength in your
Achilles tendon and leg muscles.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
diagnose an Achilles tendon problem through a
medical history and physical exam. This includes checking for tenderness, watching how you walk and stand, and comparing the range of motion of your two legs.
Other tests may be done to clarify a diagnosis or to
prepare for surgery. These tests include:
Early treatment usually results in better healing.
If your Achilles tendon shortens and
stiffens while you sleep, your doctor may suggest that you wear a
night brace to keep your foot in a neutral
position (not pointing up or down).
If you keep having pain or
stiffness in the ankle area, your doctor may prescribe a walking
boot or other device for 4 to 6 weeks. This keeps your lower leg and ankle from
moving. It allows the tendon to heal.
If you still have Achilles
tendon pain after more than 6 months of consistent treatment and rest, you
might need to consider surgery.
Treatment for an Achilles
tendon rupture includes:
Don't smoke or use other tobacco
products. Smoking slows healing, because it decreases blood supply and delays
If you have an Achilles tendon rupture, your
decision about whether to have surgery will depend in part on your:
Most Achilles tendon injuries occur during
sports and can be prevented. If you had an Achilles tendon problem in the past,
it is especially important to try to prevent another injury. To help prevent injury, try to:
Home treatment is often used for
Achilles tendinopathy as part of
physical therapy or rehabilitation (rehab) after an Achilles
Follow these steps to rest,
heal, and strengthen your Achilles tendon and prevent further injury:
If your Achilles tendon shortens and
stiffens while you sleep, your doctor may suggest that you wear a
night brace to keep your foot in a neutral position.
No matter how you treat an Achilles tendon rupture, after treatment it's important to follow your
rehab program. This program helps your tendon heal and
prevents further injury.
You can use medicine to relieve pain from
Achilles tendinopathy or an
Achilles tendon rupture. The medicine may be prescription or
nonprescription. Be safe with medicines. Read and follow all instructions on the label.
injections, which sometimes are injected around tendons or into joints to
reduce pain and
inflammation, aren't used to treat Achilles
tendinopathy. They may increase the risk of a tendon rupture.
Surgery usually isn't
needed to treat
Achilles tendinopathy. But in rare cases, someone
might consider surgery when rubbing between the tendon and the tissue covering
the tendon (tendon sheath) causes the sheath to become thick and fibrous.
Surgery can be done to remove the fibrous tissue and repair any small tendon
tears. This may also help prevent an Achilles tendon
Surgery is often used to
reattach the ends of a ruptured Achilles tendon. It may provide a better chance of
preventing the tendon from rupturing again compared to using a cast or other device that will keep your lower leg and ankle from moving
Surgery works best when you
have surgery soon after your injury. Recovering from surgery may take
months. Most surgeons will wait a few days for swelling to go down, then do the surgery as soon as possible. Surgery is usually done within 4 to 6 weeks. You will also need a
rehabilitation (rehab) program to help heal and strengthen the
Surgery for an Achilles tendon rupture
can be done with a single large incision, which is called open surgery. Or it can be done with several small incisions. This is called percutaneous surgery.
The differences in age and
activity levels of people who get surgery can make it hard to know if Achilles
tendon surgery is effective. The success of your surgery can depend on:
Talk to your surgeon about his or her surgical
experience. Ask about his or her success rate with the technique that would best treat your
Other treatments are often used
Achilles tendinopathy or
rupture. Before using other treatments, you most
likely will try rest and medicine to reduce pain and swelling.
cast or similar device can be used to prevent the
lower leg and ankle from moving (immobilization). This type of treatment may take as
long as 6 months to completely heal a tendon. This is usually followed by a
rehabilitation (rehab) program that helps you regain strength
and flexibility in the tendon and leg. The rehab program may include
physical therapy treatments include:
If other treatment doesn't reduce your pain, your doctor may recommend using a cast or other device for 4 to 6 weeks. These devices can prevent your lower
leg and ankle from moving and allow the tendon to heal. This is then followed
by physical therapy and changes in your activities.
Medical researchers continue to study new ways to treat tendon injuries. Talk to your doctor if you are interested in experimental treatments. Some of the treatments being studied include:
Khan RJK, Smith RLC (2010). Surgical interventions for treating acute Achilles tendon ruptures. Cochrane Database of Systematic Reviews (9).
Other Works Consulted
American Academy of Orthopaedic Surgeons (2009). Diagnosis and Treatment of Acute Achilles Tendon Rupture: Guideline and Evidence Report. Available online: http://www.aaos.org/research/guidelines/atrguideline.asp.
Maffulli N, Ajis A (2008). Management of chronic ruptures of the Achilles tendon. Journal of Bone and Joint Surgery, 90(6): 1348–1360.
Reddy SS, et al. (2009). Surgical treatment for chronic disease and disorders of the Achilles tendon. Journal of the American Academy of Orthopaedic Surgeons, 17(1): 3–14.
Srinivasan RC, et al. (2010). Orthopedic surgery. In Current Diagnosis and Treatment: Surgery, 13th ed., pp. 1006–1091. New York: McGraw-Hill.
Stretanski MF (2015). Achilles tendinopathy. In WR Frontera et al., eds., Essentials of Physical Medicine and Rehabilitation, 3rd ed., pp. 419–422. Philadelphia: Saunders.
ByHealthwise StaffPrimary Medical ReviewerAnne C. Poinier, MD - Internal MedicineE. Gregory Thompson, MD - Internal MedicineAdam Husney, MD - Family MedicineSpecialist Medical ReviewerDavid Bardana, MD, FRCSC - Orthopedic Surgery, Sports Medicine
Current as ofMay 23, 2016
Current as of:
May 23, 2016
Anne C. Poinier, MD - Internal Medicine & E. Gregory Thompson, MD - Internal Medicine & Adam Husney, MD - Family Medicine & David Bardana, MD, FRCSC - Orthopedic Surgery, Sports Medicine
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